asked the Minister of Health whether he is aware that users in the Shrewsbury area of Delta invalid cars supplied by his Department have to be sent to Bilston, Staffordshire, for minor repairs; and whether he will take steps to arrange repair facilities in Shrewsbury.

No, Sir. Minor repairs can already be carried out in Shrewsbury.

Could my hon. Friend tell me the distinction between major and minor repairs, because this and other matters relevant to these tricycles should be given the widest possible publicity in the interests of users?

I quite agree with what my hon. Friend has said. Work costing less than £10 in labour charges can be done in any garage, and there are at least two garages in Shrewsbury which can handle this work. I have sent particulars to my hon. Friend.

asked the Minister of Health whether he will take steps to make an annual cash allowance to invalids entitled to an invalid car from his Department, who buy their own cars because of the need to have a passenger travelling with them, equivalent to the annual cost of providing them with invalid cars.

No, Sir.

Will my hon. Friend give me the reasons for not accepting what I, at any rate, think is a very fair suggestion? Will he give an undertaking to look again at the whole question?

The reason is that my right hon. Friend has no power to give cash allowances to National Health Service patients. His function is to provide services. While I appreciate the point which my hon. Friend is making, I hardly think that it would be right to give priority to this benefit over other claims on any additional money which might be made available for transport for the disabled. The answer to the second question is "Yes".

asked the Minister of Health what steps are being taken to ensure that there are enough public health inspectors to deal with the work involved in slum clearance and multi-occupied houses.

asked the Minister of Health what steps he intends to take to secure the trained public health inspectors needed to cope with the additional work involved for them in the Government's proposals for installing baths, inside water closets, and hot water in houses, and for controlling houses in multiple occupation.

The Public Health Inspectors' Education Board is responsible for keeping the level of recruitment under review, and my right hon. Friend is in touch with it on this subject, after consultation with my right hon. Friend the Minister of Housing and Local Government.

Is the hon. Gentleman aware that that sort of Answer does not find the public health inspectors which every local authority needs? The Minister of Housing and Local Government has made great play about the attack on slum clearance, on multi-occupied houses and other factors in the housing programme, but local authorities cannot get public health inspectors to start to do this work in addition to all the work they do under the Ministry of Health. To give an instance, out of a complement of 33 we are 11 short in my constituency and cannot get inspectors even though we train them. Does not the hon. Gentleman think that this subject needs a complete review of the salaries paid to these people if we are to attract them into this difficult and, on many occasions, not very pleasant occupation?

The question of remuneration is quite another matter. Perhaps the hon. Lady will put a Question on the Order Paper about that. As to a review, as I have said, the Board has been asked to look at this matter and to consider methods by which the number of inspectors in training might be increased and to make a new assessment of the possible future intake required. That is the only step which can be taken to meet the hon. Lady's suggestion.

Surely the hon. Gentleman must be aware of the serious discontent over salaries in this profession? What does he propose to do about it? Is he aware that, in spite of this fact, public health inspectors, with great public spirit, are considering proposals for accepting technical assistance to increase the amount of work they can do? Will he look at these two proposals?

I cannot discuss the question of remuneration. The other considerations raised by the hon. Member are for the Board. The Board has been asked to consider methods by which this shortage can be remedied, and I have no reason to believe that it will be dilatory in the task.

Can the hon. Gentleman give some idea how long we shall have to wait for this statement about increased recruitment? The City of Cardiff is under-staffed in this respect. Is he further aware that it is impossible for public health inspectors to bring to bear the pressure which they ought to bring on property owners who are not keeping their property in a fit and proper condition for the simple reason that we have not numbers enough to go round?

My right hon. Friend has no precise information about the shortages, but I am aware that they exist in certain areas. My answer to the hon. Gentleman's first question is "Not without notice."

asked the Minister of Health if he is aware of the high cost of diabetic packs compared with the value of the goods in them; and what action he proposes to take.

The price to the National Health Service of one of the two packs in common use has recently been reduced and my right hon. Friend has no reason to question it. Discussions about the price of the second pack are in progress with the manufacturer.

I am not only concerned with the price to the National Health Service, which is an important factor, but with the fact that some of the people who buy these packs themselves are asked to pay 10s. for a pack, which is a small Perspex case, when the commodity in it costs about 4s. 9d. Thus, they are paying 5s. 3d. for the small pack. If this is happening in the National Health Service, is it not time that steps were taken to see that the National Health Service and the private person who buys these packs are not asked to pay such high prices merely for the pack which contains the commodity? These firms have been looked at before now.

The hon. Lady could not have heard my Answer. I said that the price of one of the two packs in common use has recently been reduced. I have no information which supports the suggestion that the pack costs as much as she says. If she will give me information I will certainly look into it. All I would say is that discussions about manufacturing costs and prices in respect of the second pack are under way now.

To how much has the price of that pack been reduced?

Since 1st October, it has been reduced to 8s. 2d.

That is still 2s. too much.

asked the Minister of Health how many trained cytologists are at present working in England and Wales on examination of cervical smears; and what plans he has for increasing their number.

There are no separate figures; the work is done at hospital laboratories throughout the country; I would refer the hon. Member to my reply of 2nd December to the hon. Member for Middles rough, West (Mr. Bray), about expansion both of the services and of training arrangements.

Will the Minister consider an article which recently appeared in which the figure of 30 to 40 was given? Will he explain how this was calculated at the time? On the second part of his Answer, is the Minister's aim that eventually screening should be offered to all women in the age group at risk? His answer to my hon. Friend the Member for Middlesbrough, West (Mr. Bray) seemed to be slightly different from the answer given by his predecessor. If that is his aim, when does he hope that it will be accomplished?

I certainly accept the principle of routine screening for all women at risk, but of course we cannot achieve this all at once. What we must do is expand the services as quickly as the expansion of trained staff and the resources of the boards will permit. Additional funds are being provided on the approval of schemes for the setting up and running of the special training centres, and once they are set up I hope that the number of experienced staff required will be provided by these and other means within about two years.

The Minister's supplementary answer is very welcome. Does he say that it is only a shortage of trained cytologists which stands in the way of developing this into a routine system? If that is the case, what consideration has his Department given to the experimental trial of the machine testing of smears, which I understand has been carried out with some fairly promising results in the London Hospitals?

I should like to look into the latter question. Answering the first part of the question, it is for each hospital board to decide the degree of priority it can give to cytological facilities, and we have made it clear to them that the Ministry of Health thinks that they should treat these services not only as important but as deserving of special consideration. I think that the hon. Member is right in his supposition that the main trouble at present is the lack of trained cytologists and technicians.

asked the Minister of Health if he will bring forward legislation to make provision under the National Health Service for a general practitioner to prescribe Complan for patients without being subject to surcharge.

No, Sir.

I appreciate the difficulties involved, but the hon. Member is aware that some months ago I took up a case with his Department concerning a doctor in my constituency who had been surcharged a considerable sum of money because he prescribed something to a 17-year-old girl patient in order to save her life? In view of the harsh treatment meted out to this doctor and the distressing circumstances, of which the hon. Member is fully aware, will he have further investigations made into the matter with the object of returning the doctor's money?

I am always willing to look into any special case, but it is important to put on record what the position is. Under the Acts, a doctor may prescribe any drug or medicine which he considers necessary for a patient's treatment. He is not entitled to prescribe any preparation which is not in the circumstances of the case a drug, and Complan is specifically classified as a food and not a drug by the Standing Joint Committee on the Classification of Proprietary Preparations. Any case of doubt is referred to independent referees. It would be wrong for that very fair arrangement to be interfered with.

asked the Minister of Health if he has reconsidered the proposal to make incontinence pads freely available on form EC 10 by their inclusion in the official list for England and Wales, as in Scotland.

My right hon. Friend's predecessor decided that they should be supplied through the local authorities and a circular has been sent to them commending their provision.

Why are there anomalies as between the practice in Scotlandand the practice in England and Wales? Would the Joint Parliamentary Secretary be kind enough to have a look at the special list again and see what the differences are between England and Wales and Scotland in this respect? Would he tell us, probably on some other occasion, that in fact in Scotland we seem to have the best end of the stick in this regard?

It is not for me to inquire into why there should be anomalies in Scotland.

No, in England and Wales.

The position is, as we see it, that incontinence pads are an item of nursing equipment required for care or after-care rather than an item for medical treatment. A circular was issued last July. I accept what the hon. Gentleman says. We will review the position as soon as there has been time to judge its effect.

Is not this a nonsensical position, in view of the shortage of geriatric beds in hospitals? Incontinence pads have been supplied in England in geriatric units in order to keep patients out of hospital. Provision such as they have in Scotland would save the National Health Service money. Will not the Joint Parliamentary Secretary re-examine this position?

I think not. I see no reason why the present arrangement should not work. As I have just told the House, we will see how it works and review the matter, if necessary.

asked the Minister of Health if he will seek power to assume complete responsibility for dental health education throughout England and Wales.

No, Sir.

If dental health education is a valuable means of ensuring that the public generally, and young people particularly, clean their teeth regularly and go to the dentist at fixed intervals, surely this ought to be a national responsibility? Are not we running into danger that, by placing the onus on local health authorities, there will be tremendous variations over different regions and that dental health will suffer in consequence?

I agree with the hon. Gentleman about the importance of education in this respect, but I do not think that it would be right to exclude local health authorities and other bodies from this field. As some hon. Members will know, there has been a review of dental health education by the Joint Committee on Health Education, and I hope that it will not be too long before I receive its Report. Then I will consider all these matters.

Would it not be better to follow the suggestion of the hon. Member for Orpington (Mr. Lubbock) rather than poisoning our drinking water with sodium fluoride at £100 a ton?

asked the Minister of Health what steps he is taking to provide funds for the postgraduate medical education of doctors employed in the health service.

I am considering how this should be further developed.

What are the difficulties? Is there some inter-departmental dispute about who is responsible? Why does not the right hon. Gentleman get on with the job and accept his responsibility in this matter?

As the hon. Gentleman knows, the training of doctors is part of the day-to-day work in hospitals, but I quite agree that there is need to expand postgraduate medical education in a methodical way, particularly in the non-teaching hospitals. The Ministry of Health, in conjunction with the University Grants Committee, which is very involved in all this, considered with the medical profession and other major interested bodies, at a conference on 22nd November—not so long ago—the lines on which regional boards should be encouraged to expand existing facilities and to plan future developments using Exchequer funds. The next stage will be to discuss this with the boards.

asked the Minister of Health what action he proposes to take to alter the present distribution of remuneration between those general practitioners providing a high standard of service and those who do less.

asked the Minister of Health if he will initiate discussions with representatives of the medical profession, with a view to amending the basis for reimbursing general practice expenses.

Discussions with representatives of the profession on the method of reimbursing family doctors' practice expenses will begin tomorrow.

Can the Minister tell us what form these discussions are taking? When he says that they are being undertaken with the profession, does that mean with the General Medical Services Committee or with an ad hoc working party which he is establishing? Does this all mean that the Review Body is now no longer the proper channel for the adjustment of doctors' expenses and remuneration, or are these talks in addition to or will they supersede the work of the Review Body? Does it also mean that the Review Body is now responsible to the Minister instead of to the Prime Minister, as hitherto?

The answer to the latter part of the hon. Member's supplementary question is "No, Sir." It is certainly not taking the place of the Review Body and, in reply to the first part, these discussions are taking place between officials of the Ministry of Health and representatives selected by the British Medical Association.

Is the right hon. Gentleman aware how gratified I was to learn, from what I think was his first speech as Minister, that he expressed a view which had been urged from this Dispatch Box upon his predecessor with a singular lack of success for the last two years, and may I congratulate him on the change of policy? May I at the same time ask him whether these talks will be limited to the question of practice expenses and reimbursement, or whether they will embrace the whole question of the pool system of remuneration?

The talks are limited to the question of the reimbursement of practice expanses, but that is one part of the pool arrangements. The discussions, which will start tomorrow, will be limited in that way. As to the hon. Member's suggestion that there had been some change of policy, that is a little unfair on my right hon. Friend my predecessor because these matters differ from month to month and one of our great difficulties is, as every member of the medical profession who looks at this subject objectively knows, that it is not easy to find out exactly what the doctors themselves would like. But I hope that we shall in due course find this out.

asked the Minister of Health why the death-rate from bronchitis in Salford is 168 per 100,000 people, which is the highest in the country, compared with a national average of 71;and what steps he proposes to take to help the city.

The reasons for local variations are not fully known; but I would refer the hon. Member to the full statement I made in the Adjournment debate on 15th February about the probable causes of bronchitis, and the measures that are being taken to lessen them.

Is the hon. Gentleman aware that local doctors blame, in particular, the damp and overcrowded rooms in old houses lacking damp courses? Some of the rooms are so wet that even the wallpaper will not stick on the walls but just peels off. Will the Parliamentary Secretary point out these facts to his right hon. Friend the Minister of Housing and Local Government, and urge him to grant extra financial assistance to rehouse those in old cities such as Salford?

The factors affecting the mortality from bronchitis are complex—and this could be one of them in Salford—but the two main causes are believed to be air pollution and cigarette smoking. I have no doubt that the Ministry of Housing and Local Government will take due note of what the hon. Gentleman has said.

The Minister keeps saying that it may be this or it may be that, but what research is going on through the National Health Service it self in those areas which are the worst sufferers, like parts of Lancashire and Staffordshire—though I do not know that cigarette smoking is exceptionally higher in those places than in mid-Scotland and other places—to enable local authorities to find out what action they should take to try to combat this terribly high death roll from bronchitis?

The Standing Medical Advisory Committee of the Central Health Services Council has been engaged on a study of the likely causes. As I say, there is no simple answer; this is a complex matter. Smoking plays some part; smoke pollution probably plays a very great part.

asked the Minister of Health to what extent research is being carried out through the National Health Service on the causes and incidence of death from bronchitis by occupation and by area of the country.

A number of hospitals and doctors co-operate in such research, and much research on bronchitis is carried out in universities or under the Medical Research Council.

Can the Minister tell us a little more about this? Is he aware of the opinion widely held in certain parts of the country that chronic bronchitis is an occupational hazard and that research should be done to establish whether it should be incorporated in the Insurance Scheme as an occupational hazard, just as the Ministry ought to advise local health authorities on certain measures which could be taken in the localities? Will the Minister publish something shortly bearing on this matter?

I expect that the hon. Gentleman knows that studies of occupational and area mortality are carried out by the Registrar-General, and the most recent reports by him were published between 1954 and 1958. He will know, also, that I am advised generally on the problems of bronchitis by my Standing Medical Advisory Committee, which is at present giving special attention to bronchitis. I am awaiting its recommendations.

asked the Minister of Health if he will make funds available to develop the tomograph, a machine which can be used for cancer detection on the soft tissues of the human body.

Ultrasonic methods of diagnosis, including tomography, are being developed at a number of centres within the National Health Service.

Is the Minister aware that a British scientist, Dr. John Gordon, has put ten years of research into the development of this machine and has also spent £9,000 of his own money in doing so? Is he further aware that America has expressed some interest in this machine; and that it has no detrimental effect on the tissues of the human body? In view of what I have said, will the hon. Gentleman look at the machine and send experts to see what possibilities are latent in it, so that we can have the best possible treatment for people suffering from cancer and those In the early stages who do not know that they are suffering from it? This machine will diagnose cancer of the liver and breast in the very early stages.

It is true that ultrasonic methods of tomography are being used experimentally in some of our hospitals, and that tomography is already one of the routine radiological procedures in cancer detection, but the hon. Gentleman must not assume that ultrasonic methods will completely replace those widely in use now. I will, however, certainly take his suggestion into account.

asked the Minister of Health, what is the shortage of trained maternity nurses or midwives for domiciliary service and of home helps for maternity cases in the North-Eastern Metropolitan Region; and what steps are being taken to overcome this shortage.

Two of the local health authorities in this area are seeking to recruit more midwives, but the domiciliary service has everywhere been equal to the demands on it. Present numbers of home helps permit all the authorities to meet the needs of maternity cases, which receive priority.

The Minister has not given the exact number. Can he say whether the number, or the percentage, is higher or lower than it is in other parts of the country? Will he not appreciate that there is a very serious shortage of maternity nurses in this area, as well as in other areas? As it is impossible to order a decrease in the birth rate, should there not be more facilities for these mothers to bear their children?

As a result of the hon. Gentleman's Question, I have made considerable inquiries from four county councils and three county borough councils. Where the midwifery staff is below strength, as it is in Essex and Hertfordshire, the authorities are making every effort to recruit staff and are taking steps to improve the conditions of service; for example, by providing houses, by providing cars, and by arranging to rotate all-night duties. But, in general, the answer is as I gave it him a moment ago.

Will the Minister agree with the recent impressive statement that a largo number of babies are dying every year because of the lack of this kind of service?

The hon. Gentleman is no doubt referring to the two reports published last week. I could not be other than concerned even if only one solitary family tragedy were to occur, and I certainly do not wish to minimise the importance of the reports or the seriousness of the situation. But I think that the hon. Member should bear in mind that the main survey to which he has referred took place in 1958—more than five years ago. There has been very considerable improvement since then. The number of hospital maternity beds, the number of midwives and the number of confinements in hospitals have all been increasing year by year. Perhaps I could add just one other point—[Interruption.] If the right hon. Gentleman had read the Report he would appreciate its importance. Since 1958, when that survey took place, mortality rates have been going down steadily. The perinatal rate has fallen from 35 in 1958 to 30·8 in 1962, and the still-birth rate from 21·5 to 18·1 in the same period.

asked the Minister of Health what further efforts are being made in the treatment of alcoholism as a chronic disease; how many institutions or special wards are specifically devoted to this purpose, in particular in the London area; approximately how many patients are thus receiving treatment; and what is the percentage of recoveries.

The facilities provided by hospital boards and other bodies are being expanded. Ten special units are specifically devoted to this purpose, of which three are in the London area. About 150 patients are receiving treatment at the present time. Comprehensive figures about recoveries are not available.

Would not the Minister agree the t this is quite an inadequate service for this type of disease, as disease it is recognised to be? Would he not agree that there are only two major institutions dealing with this disease at present? In those circumstances, will not he secure some special inquiry into the whole question of alcoholism—if possible, with the co-operation of Alcoholics Anonymous?

I do not think that the hon. Gentleman is really justified in those strictures, because four of these units have been established this year and another nine are under consideration. Of course, many of these types of patients are admitted to hospitals without special units, but it is interesting to note that the number of hospital admissions for alcoholism and alcohol psychosis has increased from 775 in 1953 to about 2,760 in 1961. Of course, to some extent, this is due to the increased willingness of people to receive treatment.

Would not the Minister agree that the units in operation, and planned, are still only sufficient to scratch the surface of the problem, which is very extensive? Would he not also agree that many hospital authorities would like to start these units if they were not limited, under the edict of his predecessor, to 2 per cent. development per annum; and that the greatest service he could do would be to be a little more generous with revenue expenditure in the coming year?

I do not know about that, but I am sure that it is right to continue the practice applied by my predecessor, and other Ministers of Health before me, of leaving it to the boards themselves to decide the priorities. Therefore, it must remain for each hospital authority to decide, bearing in mind the other great needs of the hospital service, what preference they should give to alcoholics.

asked the Minister of Health what increases are proposed during the period covered by the Health and Welfare Plan in the numbers of health visitors, home nurses and social workers employed by local authorities.

Local health and welfare authorities propose an increase between 1962 and 1972 of some 2,400 health visitors. 2,100 home nurses and 1,900 social workers, all whole-time equivalents.

I welcome the increase in these very valuable services, but does my right hon. Friend expect that they will be adequate to meet the increased responsibilities falling on the professions? Further, can he say whether the Council for Training in Social Work will be reviewing its training facilities in the light of the figures which he has given?

I am a little new to the job, but, from what I have seen so far, I should have thought it likely that more of these people would be required, and, of course, the arrangement made by my predecessor was that there would be revision from year to year. As regards training facilities, there are councils for the training of health visitors and for training in social work, and I have no doubt that both these bodies will bear in mind the increased demand which we expect.

asked the Minister of Health whether, in view of recent statements made by him in regard to vaginal cytology, he will now give an assurance that regional boards which are able to provide special courses in cytology will receive additional Exchequer funds to help in this work.

I have invited one regional board and four boards of governors to provide special training centres and have promised them additional funds for the purpose.

I thank my right hon. Friend for that reply, but may I have an assurance that the additional funds which he is to provide will not be used simply for the training and salaries of technicians but that there will be something extra in order to carry on this very necessary work?

The additional funds are, I fear, solely in respect of training. If I may give my hon. Friend one little bit of good news, he will be pleased to know that the Newcastle Regional Hospital Board is one of the boards invited to co-operate.

Will the Minister assure the House and the women in this country that he will do everything possible in this matter, since this is one of the cancers which can be cured if early treatment is given?

Yes; I think that the hon. Lady will find, when she looks at what I have said now and also in answer to an earlier Question, that I have given advice to regional hospital boards in line with what she asks.

asked the Minister of Health what increases there have been in the nursing staff at St. George's Hospital, Hornchurch, since 28th March, 1963;and whether a consultant geriatrician has now been appointed by the regional hospital board.

The nursing staff has increased by 17. It has not yet been possible to appoint a consultant geriatrician, and the post has been re-advertised.

Does the hon. Gentleman agree that the latter part of that Answer is very disappointing, since this was the brightest gleam of hope in his reply to the Adjournment debate on 28th March last? Can he say how many consultants have considered this post and whether the existing nursing staff—on whom, of course, there is no reflection at all—are being specially trained in this difficult and often unpleasant geriatric work?

I do not agree that the Answer is a disappointing one. Despite the difficulties at this hospital, there has been an increase in the nursing staff, including 13 trained staff. The post of consultant geriatrician has been advertised on two occasions, but the applicants interviewed were not considered suitable. A third advertisement has now gone out and the appointments committee will interview applicants on 16th January. Three applications have been received so far.

Is the hon. Gentleman aware that there appear to be an unusual number of complaints about this hospital, many of which have reached me" Is there nothing which the Department can do to assist the hospital on these important matters?

I am sure that, with his special knowledge of these matters, the hon. Member will know that continuing adverse publicity does not help recruitment. In this particular case, the hospital authorities are to be congratulated in managing to increase the number of nurses in an area where it has been difficult to effect recruitment up to now.

asked the Minister of Health in view of the designation of the new town of Dawley, what discussions he has had with the new town corporation and The Wrekin Hospital authorities concerning the need for a new maternity hospital unit at The Wrekin Hospital, taking into account that the maternity services in the area cannot stand the strain of the additional population due to arrive in the new town.

Discussions have already been held between Officers of the regional hospital board and the development corporation; further population estimates are now awaited from the corporation so as to assess the need for additional maternity and other hospital facilities.

I thank the Minister for that reply for the moment. Does he realise that his predecessor visited the area six months ago and that already the medical practitioners' committee in the area have said that the situation is getting such that they cannot manage? How muchlonger have we to wait before we can have a reply about the maternity unit? Will it be before Christmas, or afterwards?

I can probably help my hon. Friend to some extent. A new maternity unit with over 80 beds, with full and continuous consultant coverage, will be the first phase of the new district general hospital at Copthorne. Building work is expected to begin next year. As for the short term, I am informed that the immediate need of The Wrekin Hospital is not additional maternity beds. In fact, bed occupancy at this unit has been on average only about two-thirds during the past two years.

In order to save time, I should like to give notice that I shall raise the matter on the Adjournment as soon as possible.

asked the Minister of Health what is the approximate average waiting time for out patients attending the London teaching hospitals; and if he will impress on the management boards concerned the continual need for inspection of the procedures they adopt for out-patient attendance.

I am afraid that it is not practicable to calculate such a figure. The answer to the second part of the Question is, "Yes, Sir".

Would my hon. Friend bear in mind that recently I received a complaint from a woman who was kept waiting for two and a half hours in the out-patient department of a certain London hospital? On inquiry I found that this was in no way exceptional. Indeed, there are delays of two hours or more in most London hospitals. Would my hon. Friend impress on the management committees concerned that their otherwise admirable service is falling down very badly at out-patient level?

I appreciate very much the point my hon. Friend is making. I can assure him that we are just as anxious as he is to eliminate undue waiting time for out-patients, both for appointments and at the hospital. There would not be any advantage in trying to establish an average waiting time. I am sure my hon. Friend would agree that it is particular sources of complaint and not average performance that need to be tackled. I am prepared vigorously to pursue any instance of undue waiting that is brought to my notice.

Is the Joint Parliamentary Secretary aware that, confirming what the hon. Member for Brentford and Chiswick (Mr. Dudley Smith) has said, there are at least indications that the London teaching hospitals are amongst the worst offenders in this respect? Has his Department considered recommending to hospital authorities the automatic monitoring system for out-patient departments which has been used experimentally in the Cardiff Royal Infirmary, with promising results which are described in the current issue of the Journal of Medical Care?

Yes. We are always alive to what it is necessary to do to keep the hospital authorities up to the mark. We cannot continuously lecture them on the subject. On the other hand, the kind of suggestion the hon. Gentleman has made is one that my right hon. Friend will bear in mind when next considering the issue of a hospital memorandum or some other guidance.

asked the Minister of Health how many new hospitals were completed in 1960 and in 1961 in England and Wales.

In 1960, phases of three new and two substantially remodelled hospitals, and in 1961, phases of three new and one substantially remodelled hospital, were completed and brought into use.

Does the Minister realise that that Answer, together with the Answer he gave me last week on a comparable matter, in fact show a shortfall in spending of £140 million in a period of four years? Does he realise that his predecessor promised us a rate of spending of £70 million a year and to that end imposed health taxes amounting to £70 million a year upon the chronic sick? Would he like to justify this?

With respect to the hon. Gentleman, he is wrong on both counts. I will give him the figures. The Hospital Plan assumed expenditure in the first five years of £200 million—that is to say, an average of £40 million a year. At current prices, this is the equivalent of £45 million a year. The amount we expect to spend in this financial year is £46 million. Next year we plan to spend £52 million. With regard to the second part of the hon. Gentleman's supplementary question, I think that the progress of the building programme in the Hospital Plan can be better gauged by comparing the volume of work in progress when the Plan was published, which was £70 million, with that at the present time which is, not the figure the hon. Gentleman mentioned, but £120 million.

May I draw the Minister's attention to his predecessor's speech in February 1960 in which his predecessor said that these taxes would be spent entirely on hospital building programmes? May I remind the Minister that these taxes were raised in 1960 by £68 million and in 1961 and thereafter by a sum in excess of that? Is not this a gross deception of Parliament and the people?

If the hon. Gentleman is contemplating removing National Health Service contributions and charges to patients, the cost would be something in the region of £190 million. One could recoup that by increasing the standard rate of Income Tax by 6d. in the £.

asked the Minister of Health what proposals he has had from the regional hospital board about changes in the plans for the new general hospital in King's Lynn; whether it will be possible to build on an enlargement of the present site; and when he hopes to authorise a start to be made.

None, Sir; some additional land will be required; in the years 1966–67 to 1970–71.

Do I understand from my hon. Friend's reply that he has received no proposals for a change in the Plan and that therefore the building of the hospital will go on as was announced earlier? If so, this will rather dash the hopes of local people, who had hoped that there would be a very considerable extended plan for addition to the general hospital? There is a general wish in the town that this should be, if possible, in town and on the present site.

I do not think my hon. Friend is justified in being so pessimistic. The regional board's planning of this new hospital is in a preliminary stage, and for that reason no firm forecast for the starting date can be given. If my hon. Friend would like to write to me or come to see me about this, I can perhaps give him more information.

asked the Minister of Health to what extent delays in surgical operations are caused by the shortage of anaesthetists.

Shortage of consultant anaesthetists may caused some delay in non-urgent cases. Additional posts are being created.

Is not the hon. Gentleman aware that in some areas anaesthetists spend up to fifteen hours in the theatre? Is he not aware that this can cause danger to the patients? Will he make an effort to increase the number of consultants and senior anaesthetists and do something at least to plan the use of anaesthetists so that patients are not subject to this kind of risk?

I am not aware of any delay in urgent cases caused by shortage of anaesthetists. The number of senior registrars in training as anaesthetists is being increased in order to increase the number of consultants, but the process obviously must be gradual. Senior registrar posts must give adequate training, and candidates for them must be of proper standard. Therefore, the answer to the hon. Gentleman's last question is that we are examining now with the Joint Consultants' Committee the reports of boards on their long-term reviews of medical staffing.

asked the Minister of Health whether he is satisfied that there is sufficient hospital accommodation for permanently mentally sick cases of young people under the age of 18; and what are his proposals for making good the shortage.

There is a shortage of special accommodation; the Standing Mental Health Advisory Committee, which was asked to examine this problem, has recently reported to me and I shall soon be issuing advice to regional hospital boards.

Is it not an understatement merely to say that there is a shortage? Is it not true to say that there is no room at all and that only if a parent can afford £17 a week for a child do the facilities exist? Will the Minister see that the matter is hurried up, firstly because of the serious nature of this matter and, secondly, because the lack of room has caused considerable trouble, particularly in court cases, where no facilities have been found for children of this description?

I will certainly do everything I can to hurry it up. Indeed, the advice which is to be given to regional hospital boards—within a couple of weeks or so, I hope—will suggest interim targets based on current knowledge we have of needs.

Is the Minister aware that the very progressive West Ham Borough Council will next year open the finest hospital for mentally handicapped children in the world and that the council will be calling it the John F. Kennedy Memorial Hospital? Will the right hon. Gentleman encourage other local authorities to follow the good example of West Ham Borough Council, which happens to be Labour-controlled?

asked the Minister of Health if he is aware of the concern aroused by the report of the three scientists commissioned by the Nuffield Provincial Hospitals Trust, a copy of which has been sent to him, concerning the state of kitchens and food in many hospitals; what study he has made of the report; and if he will make a statement.

asked the Minister of Health if he is aware of the facts revealed in the Nuffield Provincial Hospitals Trust's report on food in hospitals, a copy of which has been sent to him; what steps he proposes to take to ensure that the recommendations in the report are implemented as a matter of urgency; and if he will make a statement.

I am still studying this report. The survey on which it was based was made in 1960, 1961 and 1962, and considerable improvements have since been and are being made. Most of the recommendations are already included in the advice given by the Ministry of Health on catering problems, including meal content, preparation and service, and the avoidance of unnecessary waste. I welcome the report as a further stimulus to hospital authorities to secure universally high standards.

Is the Minister saying that the conditions which were revealed by these highly responsible and qualified people do not exist today, or is he saying that part of them has been altered? Can he tell us who has got into trouble at the Ministry of Health for allowing such conditions to exist and how can the skill of our doctors and nurses be helped if such things as dirty kitchens and very poor food are allowed to persist?

I was saying in answer to the hon. Member that nearly two years ago, in January, 1962, advice was given to hospital authorities on how food should be prepared, cooked and served to the high standards. I can certainly assure the hon. Member that inefficient catering will get no sympathy from me. Where there is unnecessary waste or bad catering the greater the public outcry the better. After all, we are dealing with the taxpayers' money and this is a public service. However, it is grossly unfair and naïve to pretend that there is something universally wrong with hospital catering. Many hospitals are absolutely first-class, but some of the staff are having to cope with out of date facilities. We must persevere until we ensure that the general standard is brought up to the standard of the best.

Would the Minister not agree that this survey was made in 156 hospitals, which represented a scientific sample, and that although no doubt some hospitals are very good, the great majority of the larger hospitals came in for some very swingeing criticism from this distinguished body of experts? Would he not also agree that waste amounting to 40–45 per cent. of the total food prepared in hospitals is a shocking and scandalous thing which requires urgent action on his part and on that of the hospital authorities?

I think that the estimate given of the average waste of food in hospitals, not by the report but by some newspaper commentators, was somewhat exaggerated. However, I entirely agree that there is much to be done here and that if we are successful in reducing the amount of waste we shall save a considerable amount of money. I hope that hon. Members and those outside this House will—as I am sure the hon. Member for St. Pancras, North (Mr. K. Robinson) has done—read the whole of the Report, because if they do they will see that it contains a great deal of praise for some hospitals.

asked the Minister of Health if he is aware of the dissatisfaction at the continuing lack of facilities for mentally-handicapped children and of the problems that exist in areas where no hospital accommodation can be found for the mentally sick under the age of 18 years; and what decisions he has reached following consideration of the Scott and Underwood Reports.

Facilities provided by hospital and local health authorities are increasing; advice on child guidance, based on the Underwood Report, was issued to these authorities in 1959; decisions on the Scott Report were announced to the House by my predecessor on 30th May in reply to my hon. Friend the Member for Bradford, West (Mr. Tiley).

Does the right hon. Gentleman not appreciate that the facilities available for mentally handicapped children have been woefully inadequate for all too long, and is this not a terrible thing for parents of such children? Should not we, the rest of the community, try to do our utmost to help, bearing in mind the blow that falls on any family with such a child?

I entirely agree with the hon. Member. Long before I came to the Ministry of Health I was the president of my local branch of the Society for Mentally Handicapped Children, and I have, therefore, taken a considerable interest in this matter. As to the future, it is perfectly true that we need more local authority hostels and training centres for mentally abnormal children. We have plans for considerable expansion, as the hon. Member knows.

asked the Minister of Health why the secretary of the Atkinson Morley Hospital, Wimbledon, has refused to make available to Mrs. Harry Woolf or those acting on her behalf the medical record showing the late Mr. Harry Woolf's condition on admission to the hospital on 12th November, 1962.

A full medical report has already been given. In the circumstances of this particular case, I am advising the hospital to make the medical record available.

asked the Minister of Health whether he will give an assurance that he will not reduce or stop any salary or wage increases for hospital workers freely negotiated by the appropriate Whitley Councils.

No, Sir, but there would have to be very compelling reasons for me to withhold approval to a Whitley agreement.

Why does the Minister say "No, Sir"? Is he not aware of the great disgust caused throughout the country, and not only in the Health Service, when one of his predecessors did this very thing? Can he not give an assurance that he will not interfere with voluntary trade union negotiations when those negotiations go through the proper channels? What right has he to interfere when the people within the industry freely negotiate an agreement? Will he net say that he will not interfere with them?

The hon. Gentleman asks what right I have to interfere. My right derives from Regulations that came into force in 1951. The pay of National Health Service staff cannot be negotiated without reference to the national interest in the widest sense, but I very much hope that circumstances will be such that it will not fall to me to withhold approval.

asked the Minister of Health if he will make a further statement on hospital plans for North Staffordshire, with particular reference to the priority to be given to the proposed new pathological department.

Three main schemes, costing well over £1 million, to improve the hospitals at Stoke are now under construction; the next main scheme, a new maternity unit, is expected to start next summer; the pathological department is to be extended next year pending the building of a new department.

I am grateful for small mercies, but is not the Minister aware—I think that he must be from the evidence which I sent him some time ago—that the urgent need is for an entirely new pathological department in North Staffordshire to replace the early Victorian slum in which our pathologists and their staff at present have to work? They will be grateful for some alleviation next year, but when will it be possible to include in the programme, for it is really very urgent, an entirely new pathological department for this area of more than 500,000 people?

Discussion on the scope and timing of the new department is under way locally. I cannot possibly accept the stricture implied in the hon. Gentleman's first comment. The three main schemes under construction and building now are: an accident unit, with operating theatre suites, costing £400,000, to be completed in the spring of next year; a central out-patient department to serve the hospitals of Stoke costing £750,000, to be completed at the end of 1965; and neurosurgical and neurological wards at North Staffs Royal Infirmary costing £150,000, to be completed at the end of 1965. The other main scheme is a new maternity unit which will cost over £2 million. I should not describe these as small mercies.

Does not the Minister realise that I am speaking with regard to the relative need? I should be prepared to receive him on the ground in order to look at the actual situation in North Staffordshire, with its legacy of thirty years of negligence, and to examine the needs of this enormous area. Perhaps he would then consider whether this really is a programme adequate to the need.

I am always ready to meet any hon. Member. I should be delighted to meet the hon. Gentleman to discuss the particular point which is worrying him about the pathological department.

asked the Minister of Health whether he is aware that patients at Rookwood Hospital, Llandaff, Cardiff, have to be carried more than 70 yards in the open from the operating theatre to the wards because no money is available to build the covered way approved by the Rookwood Hospital House Committee eighteen months ago; and what action he proposes to take in this matter.

Yes, Sir, for a few patients from one particular ward. The Welsh Hospital Board and the Cardiff Hospital Management Committee are considering giving higher priority to the building work.

Is the Minister trying to shuffle off responsibility? Is he not aware that the hospital committee has stated that it is the rigid financial restriction imposed by his Department which is responsible for the present difficulty? Does he think, because only a few patients have to be carried from the operating theatre out into the open air a distance of between 70 and 100 yards, that this is not an urgent matter?

I am not defending it for a moment. If I may say so, the hon. Gentleman, in uncharacteristic fashion for him, has put a most unfair construction on my reply. I said that the matter was being considered now, and it may well be that, following a report from the hospital staff, the scheme will be accorded a higher priority by the hospital management committee.

Is the Minister prepared to help the hospital management committee financially to get on with the job? As he will know from the representations which have been made to his Department, it has been waiting for a considerable time.

I think that it would be best to await the outcome of the discussions which are at present under way.

asked the Minister of Health what he is doing to increase hospital confinement facilities in Nottingham; and what steps he is taking to overcome the shortage of midwives.

A new maternity unit of 168 beds is to be built for the Nottingham City Hospital; and the hospital management committees are advertising for additional midwives.

asked the Minister of Health what is the current maximum salary of a State enrolled male nurse.

£650. excluding London weighting.

Does the Minister realise that this represents for these people a decline of earnings in real terms of 5 percent. since 1949, in a period during which average earnings in manufacturing industry have increased by no less than 34 per cent.? Is he aware that most of these State enrolled nurses are getting less than the orderlies in the same wards in which they are serving and that very many valuable men are leaving the profession because of these niggardly salaries? What does he propose to do about it?

It is true that there was a net reduction of 70 male enrolled nurses last year, but the number of female State enrolled nurses—

I am talking about male enrolled nurses.

I know, but the hon. Gentleman asks for a reply to his question and he should permit me to answer. The number of female enrolled nurses has increased by a net 761. I can make no comment on the question of remuneration. The hon. Gentleman has not asked me about that in his main Question. If he will put a Question down, I will endeavour to answer it. All I will say is that the salary scale for the State enrolled nurse was fixed by the Industrial Court in an award it made last April which was put into effect on 1st July.

asked the Minister of Health if the review of medical staffing consequent upon the Platt Committee Report has now been completed; and if he will make a statement.

The review has not yet been completed.

In view of the urgent need to reduce the long waiting time in a number of hospital specialties, will the Minister seek to get this review com- pleted by the boards at an early stage? Is he aware that the hold-up for beds is very often caused by a shortage of consultants in the particular specialty? Unless the review is completed, how can more consultants be appointed in order to get cases dealt with quickly? For example, gynaecological cases sometimes have to wait as long as four or five years before they can be operated on.

At the moment, we are still awaiting reports from three boards of governors. I recognise that it is an urgent matter, but I am surprised at the point which the hon. Gentleman makes. I hope he will let me have particulars of his complaint, because my information is that new consultant posts in appropriate cases are not being held up.